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Heather Farrow

Day attempting again to lead Doctors of B.C.; Activist for private surgery clinics to f... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vasn|20160428|245795012

day bc private clinics privatization medicare doctors

shared by Heather Farrow on 02 May 16 - No Cached
  • Vancouver Sun Thu Apr 28 2016
  • Déjà vu it is as private surgery centre owner Dr. Brian Day is right back where he was a year ago, once again vying to be president of Doctors of B.C. Day won the election to become the 2016-17 president, but only by one vote. A recount requested by the runner-up, Dr. Alan Ruddiman, went in Ruddiman's favour and he will take the helm of the doctors' lobby group for one year starting in June.
  • Day is running to become the president-elect for the 2017-18 term. He's running against one other candidate, Dr. Trina Larsen Soles, a family doctor in the Kootenay town of Golden. She's vicechair of the Doctors of B.C. board of directors while Day has formerly been president of the Canadian Medical Association. Like Day, Larsen Soles has also run once before for the Doctors of B.C. presidency. She lost to current president Dr. Charles Webb.
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  • Online balloting has opened and will continue until May 15. While Day and Larsen Soles are both repeat contenders, they are distinctly different candidates who will appeal to different segments of the association's 12,000 members.
  • As an orthopedic surgeon, Day should draw more votes from specialists who have long felt the organization is too loaded with primary care doctors. Indeed, the current board of five doesn't include a single specialist and such doctors have long felt that has disadvantaged them when it comes to negotiations over fees with government. Family doctors have made impressive gains in the past two contracts while specialists, such as fee-for-service anesthesiologists, have complained bitterly about their fees and work terms. If Larsen Soles wins, she would become the fourth consecutive family doctor to be president and the second consecutive rural doctor; Ruddiman, the presidentelect, is from Oliver. She said in an interview she expects doctors will naturally want to mull those questions over.
  • "The thing is, people who choose rural medicine are those who are attracted to challenges and change and that's who doctors would be getting if they elect me. "Day, a private medicine pioneer, is hardly a stranger to challenge and change himself. Evidence of that is his seven-year-old lawsuit against the provincial government over whether private surgery clinics can bill patients for publicly insured services normally done in hospitals, usually after waiting long periods. Day said the litigation should not be a factor in the campaign, as it was last year. The oft-deferred sixmonth trial was supposed to begin in June but it has now been delayed to the fall. Day said provincial government lawyers recently asked for another deferral because they need yet more time to prepare. Providing the trial does start in September and lasts six months, as expected, if Day won the presidency, he'd be assuming the helm about four months after the trial ends. But regardless of which side in the trial wins, appeals all the way to the Supreme Court of Canada are expected in the landmark case that could reshape the health care system.
  • Day said only about 60,000 B.C. residents pay out of their own pockets to use 60 or so private surgery clinics. "I'm not saying we should privatize the health care system," he said, but he believes in a hybrid system in which private centres are used far more, as Saskatchewan is doing with its large scale contracting out of cases in which patients are waiting too long for care in hospitals. "Saskatchewan, the birthplace of socialized medicine, has taken a more pragmatic, less ideological approach, and it seems to be working. They are empowering patients to get their treatment in other places (like private surgery and radiology centres)." Larsen Soles said she's interested in the innovations in Saskatchewan but worries that a burgeoning private sector will draw health professionals away from the public sector. Sun health issues reporter pfayerman@postmedia.com twitter: @MedicineMatters
Govind Rao

Private medicine advocate voted top doc; Day could be leading group while his case agai... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vasn|20150527|221340494

from heather doctors bc Day private clinics privatization

shared by Govind Rao on 27 May 15 - No Cached
  • Vancouver Sun Wed May 27 2015
  • In an election decided by just a single vote, private medicine pioneer Dr. Brian Day got the nod Tuesday as president-elect of Doctors of B.C. Day was a last-minute candidate and immediately shook things up by telling doctors that a vote for him was a vote for patient choice and competition in health care. An orthopedic surgeon and co-owner of the Cambie Surgery Centre, Day is suing the B.C. government, arguing patients should have the constitutional is before courts right to pay for care in private clinics if waits in the public system are too long.
  • Dr. Alan Ruddiman, a family physician in Oliver who campaigned on a pro-medicare plank to distinguish himself from Day, garnered just one vote less - 945 - suggesting doctors were split on public-versus-private health care. Day will become president of the doctors' advocacy organization, formerly known as the B.C. Medical Association, in 2016/17.
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  • He will succeed Dr. Charles Webb, who takes over as president when Dr. Bill Cavers finishes his one-year term next week. Day's lawsuit is expected to last seven months and is tentatively scheduled in the B.C. Supreme Court at the end of the year. So Day could be leading Doctors of B.C. at the same time he's in court against the government.
  • Health Minister Terry Lake said that could present challenges. "I obviously want to have a positive relationship with the Doctors of B.C. I've obviously had that with the past presidents. It may pose, I guess potentially, some difficulties if we have an active legal case going forward whether I'm able to meet with the president-elect. "I don't know at this moment in time if this will provide any obstacles, but we'll seek advice on that." "But this is a democratic process, it's an organization of membership, of self advocacy, and we have a working relationship with the Doctors of B.C. and we have to obviously abide by their democratic process." Opposition health critic Judy Darcy said she's flabbergasted by the election.
  • "Brian Day has led the charge to try to bring more private forprofit health care to B.C. I know those are not values shared with the majority of B.C. doctors that I've spoken with, but it is very disturbing at a time when there's an active court case with government about bringing in more private health care in B.C. that this is the person leading the Doctors of B.C." "That's pretty serious if the minister can't meet with him because there's a legal case, but also Doctors of B.C. is involved in many, many joint committees across the province ... so I think it's very worrisome ... and I'm very concerned about what it means for health care in B.C." Darcy said patients end up in the private system out of frustration and she thinks government should do more to improve access to publicly funded care.
  • But Day said he expects his trial will be over by the time he's president because lawyers for both sides have been trying to scale it back by reducing the number of witnesses testifying. Day's lawsuit contends patients have a constitutional right to pay for private care if their health is suffering by waiting too long for care in the public health system. Under current laws, private clinics are not supposed to collect money from patients if the treatment is an insured service in the public system.
  • As to Darcy's concerns, Day said: "Everyone like that is against using the private system until you, or a family member or friend, needs it. When it becomes a personal matter, they may want and need to access care in the private sector." Referring to a front-page story in The Vancouver Sun Tuesday about the projected explosion in cancer cases due to population aging and growth, he said: "That's the sort of thing we need to be spending public health dollars on, not skiers at Whistler who harm their limbs and want quick surgical repairs."
  • Cavers said, in an interview, he couldn't comment on whether Day's simultaneous lawsuit and presidency could present conflicts or potentially awkward interactions between the government and Doctors of B.C. "I can tell you that when you are president, you are representing the interests of all doctors. It's not about your personal agenda. And if anyone has a reason to recuse themselves from board discussions, then they do that. Because sometimes interests do collide."
  • Cavers, a Victoria family doctor, said the organization is constantly interacting with the Ministry of Health on a multitude of issues involving the health system. But most often, he said, the meetings are between government staff and Doctors of B.C. staff. Cavers recalled having a halfdozen direct encounters with the health minister in the past year. Ruddiman declined to comment.
  • Dr. Lloyd Oppel, an emergency medicine physician at the University of B.C. Hospital who was third in the balloting, said he has no idea if Day's presidency will "present lots of hiccups," nor if the trial will be a distraction from Doctors of B.C. work. "Brian (Day) appeals to doctors who like his gutsy style, the fact he's not afraid to fight the good fight. They see him as a beacon of hope for change. So I knew when he entered the race that he'd have a big effect," Oppel said. Sun health issues reporter pfayerman@vancouversun.com Follow me on Twitter: @MedicineMatters Read more about Brian Day on my blog: vancouversun.com/medicinematters © 2015 Postmedia Network Inc. All rights reserved. Illustration: • Steve Bosch, PNG Files / Dr. Brian Day will become president of Doctors of B.C. in 2016-17.
Heather Farrow

Feds gear up for battle against private health care - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|bcbc|20160829|254983629

day privatization private clinics court bc

shared by Heather Farrow on 30 Aug 16 - No Cached
  • Feds gear up for battle against private health care THE NATIONAL Mon Aug 29 2016, 9:00pm ET Byline: CATHERINE CULLEN; DR. BRIAN DAY; JANE PHILPOTT WENDY MESLEY (HOST): - WENDY MESLEY (HOST): Good evening, I'm Wendy Mesley and this is "The National." DR. BRIAN DAY (CAMBIE SURGERY CENTRE):
  • Our goal is actually to fix Medicare. WENDY MESLEY (HOST): A B.C. clinic' fights to expand private health care. Catherine Cullen finds out how the federal government plans to fight back. - Justin Trudeau's Liberal government is gearing up for a fight, the outcome of which will affect all Canadians. It's a battle between public and private health care in a B.C. Court and CBC News has learned that the feds are entering the fray, armed with some powerful evidence against for-profit care. The CBC's Catherine Cullen has the details. DR. BRIAN DAY (CAMBIE SURGERY CENTRE): You have a lot of arthritis but this is not normal.
  • CATHERINE CULLEN (REPORTER): For nearly two decades the Cambie Surgery Centre has offered private healthcare. Some patients come from other countries, some are covered by workplace compensation and some are just willing to pay out of pocket for faster treatment. DR. BRIAN DAY (CAMBIE SURGERY CENTRE): What is morally wrong with Canadians spending their own money on their own health care? CATHERINE CULLEN (REPORTER): Today Dr. Brian Day is getting ready to go to court to defend that argument. DR. BRIAN DAY (CAMBIE SURGERY CENTRE): Our goal is actually to fix Medicare and that's what I think we will achieve with this lawsuit.
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  • CATHERINE CULLEN (REPORTER): The Cambie Surgery Centre is taking on the province of British Columbia in court next week, trying to overturn two provincial regulations. One bans private health insurance from medically-necessary surgeries. Advocates of private healthcare says it's too expensive for most people if there's no insurance. The other regulation forces doctors to choose between working in the public or private system rather than letting them to split their schedule. And now Justin Trudeau's government has been accepted as an intervener in the case. CBC News has obtained the expert report federal lawyers will use. It cites numerous studies to paint a bleak picture of a Canada with more private health care, arguing "society as a whole would be worse off." Resources like highly- skilled doctors would be siphoned from the public system. Even bankruptcies if people buy health insurance they can't afford as sometimes happens in the United States. Day says that he wants to see a European-style system with a public/private mix. DR. BRIAN DAY (CAMBIE SURGERY CENTRE):
  • To me it's a very simple question and that is: if the government promises health care, fails to deliver it, do they have the right under the constitution to stop you or your loved ones from extricating yourself from the pain and suffering that then ensues? CATHERINE CULLEN (REPORTER): The federal government says it's concerned about anything that would create a barrier to quality healthcare. JANE PHILPOTT (MINISTER OF HEALTH): It goes completely against the principles of the Canada Health Act which include accessibility and universality and we're committed to upholding those. CATHERINE CULLEN (REPORTER):
  • Now, the Supreme Court has already ruled on a similar case about private insurance, specifically in Québec, and in that case private healthcare won. People on both sides of the debate say that this new case could have some very important consequences for the whole country and that it could also wind up in front of the Supreme Court. Catherine Cullen, CBC News, Ottawa. © 2016 CBC. All Rights Reserved.
Govind Rao

Fired workers caught in tangled web of loopholes; THIRD OF FOUR PARTS Ontario's outdate... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150518|220709726

from heather staffing health and safety Ontario legislation standards

shared by Govind Rao on 19 May 15 - No Cached
  • Toronto Star Mon May 18 2015
  • Showed up to work one day and got fired for no reason? Sorry about your luck. In Ontario, not a single worker is protected from wrongful dismissal under the Employment Standards Act. Hit with the flu and can't make it into the office? Consider sucking it up, because chances are you won't get paid. You'll be lucky to keep your job, in fact. Have to put in extra hours one week to get the job done? Whatever you do, don't expect overtime pay - or even to get paid at all.
  • Ontario's outdated employment laws, currently under review, were designed to create basic protections for the majority of the province's non-unionized workers. Instead, millions are falling through the gaps created by a dizzying array of loopholes, from the dangerous to the downright bizarre. Construction workers have no right to take breaks on the job. Care workers aren't entitled to time off between shifts. Vets aren't entitled to vacation pay. Janitors have no right to minimum wage. Cab drivers aren't entitled to overtime pay.
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  • And dozens of occupations, some that you've never even heard of, are exempt from basic rights entirely. "Keepers of fur-bearing mammals" have no right to minimum wage. Sod layers have no limits on their daily hours of work. Shrub growers don't get a lunch break. The system is so complicated that the Ministry of Labour has developed a special online tool to help decipher who's entitled to what. But as the province reviews its antiquated Employment Standards Act, critics argue that its confusing web of exemptions makes it harder for the so-called precariously employed to defend their rights - and easier for bosses to ignore them.
  • "When you distil it down to what these exemptions are seeking to achieve, really they are to give employers more control over work and more control over wages," says Mary Gellatly of Parkdale Community Legal Services. "It sends the message to employers that they can get away without complying." The Act was first introduced in Ontario in 1968 to set basic work standards, especially for non-unionized employees who don't have a collective agreement to provide extra protections. But there are at least 45 occupations in Ontario that are exempt from a variety of its fundamental entitlements, many of them low-wage jobs in industries where precarious work is rife.
  • The Ministry of Labour says many of the exemptions are "long standing" and related to "the nature of the work performed." But York University professor Leah Vosko, who leads research into employment standards protections for the precariously employed, says exemptions have come at least in part from industry pressure, leaving the Act a "complex patchwork that is difficult for workers and even officials to comprehend." Even when there are clear violations, speaking out can come at a cost. Reprisal is illegal under the Act, meaning bosses can't penalize employees for exercising their workplace rights. But the Act gives workers no protection against wrongful dismissal. Employers do not have to give cause for firing someone.
  • Unionized employees are generally protected by their collective agreements, and workers can sue employers if they think they have been unfairly terminated. But most precarious, low-income employees are not unionized, and most do not have the money to take legal action against an employer, says Parkdale's Gellatly. "It's the big reason why many people can't do anything if they're in a workplace with substandard conditions, because they can get fired without cause." Linda Wang, who worked at a Toronto cosmetics manufacturer for four years, was fired less than two weeks after asking her employer for the extra pay she was owed for working a public holiday. She says no reason was given for her termination. Wang, a mother of two, claims her employer repeatedly bullied her and her colleagues, and says she believes she was dismissed for asking for the wages.
  • She has filed a reprisal complaint with the Ministry of Labour, but Wang cannot afford to take her employer to court. "I feel the system is against workers," she says. "It's in favour of employers." "Whatever job you have, you put so much of yourself into it," adds Gellatly. "The fact that employers can just fire you without a reason is incredibly devastating for folks." The Act also contains significant gaps when it comes to sick leave and overtime. The legislation provides most workers with 10 unpaid days of job-protected emergency leave, which means they can't be fired for taking a day off due to illness or family crisis. Critics call this measure subpar by most standards, since it still causes many workers to lose a day's income for being ill. An estimated 145 countries give employees some form of paid sick leave.
  • "Unfortunately, we stand out for our inadequacy," says Brock University professor Kendra Coulter. But the 10-day protected leave doesn't apply to almost one in three of the province's most vulnerable workers. An exemption that excludes employees in workplaces of fewer than 50 people from that right means 1.6 million workers in Ontario are not even entitled to a single, unpaid, job-protected sick day. Fast-growing, low-wage sectors such as retail, food services and health care are most likely to be exempt according to a recent report by the Workers' Action Centre. While many small businesses voluntarily give their employees paid sick days, the loophole leaves many workers - especially the precariously employed - exposed.
  • Toronto resident Gordon Butler asked his employer, a small construction company in Markham, for one day off work after he sliced his thumb open on the job. He says his boss told him not to come back. "I didn't believe him," says Butler, 44, who has an 8-month-old child. "I tried to plead with him, and he said 'No, too bad.'" "The way it's stacked up right now is there are very few options for people who are in low-wage and precarious work to actually take sick leave when they're sick," says Steve Barnes, director of policy at Toronto's Wellesley Institute, a health-policy think-tank. "They not only have to worry about lost income, but the potential for losing their jobs," adds Brock's Coulter. "It's unkind and unnecessary." The stress caused by the province's meagre sick-leave provisions is compounded by exemptions to overtime pay, to which around 1.5 million don't have full access.
  • As a rule, employees should get paid time and a half after 44 hours a week on the job, according to the Employment Standards Act. But in 2014, more than one million people in the province worked overtime, and 59 per cent of them did not get any pay whatsoever for it, Statistics Canada data shows. This, experts say, is partly because enforcement is poor. But in Ontario, a variety of occupations don't even have the right to overtime pay, including farmworkers, flower growers, IT workers, fishers and accountants. Managers are also not entitled to overtime. Vladimir Sanchez Rivera, a 45-year-old seasonal farmworker in the Niagara region, says he has worked 96-hour weeks doing back-breaking labour picking cucumbers and other produce.
  • We don't have access to protections when we are working in agriculture," he says. "And our employers tell us that." Low-wage workers are even more likely to be excluded from full overtime pay coverage, according to the Workers' Action Centre's research. Less than one third of low-income employees are fully covered by the Act's overtime provisions, compared to around 70 per cent of higher earners, because they are more likely to work in jobs that aren't eligible. Workplaces can also sign so-called "averaging provisions" with their employees, which allow bosses to average a worker's overtime over a period of up to four weeks. That means an employee could work 60 hours one week and 50 the next, but not receive any overtime as long as they don't work more than a total of 176 hours a month.
  • Critics say the measure means more work for less pay, and paves the way to erratic, unpredictable schedules. "That's a huge impact on workers and their families in terms of lost income and having to work extra hours," says Parkdale's Gellatly. "It's certainly not good for workers, for their families, and it's not good for creating decent jobs in terms of rebooting our economy," she adds. For many of the precariously employed, falling through the gaps ruins lives. "Even now, when I think about the working environment, I feel very depressed," says Wang, who, 10 months later, is still waiting for the Ministry of Labour to issue a ruling on her complaint. "I feel panic."
  • Sara Mojtehedzadeh can be reached at 416-869-4195 or smojtehedzadeh@thestar.ca. By the numbers 1.6 million non-unionized Ontario employees with no right to an unpaid, job-protected sick day 59%
  • of Ontario workers who worked overtime in 2014 did not get any pay whatsoever for it 71% of low-wage, non-unionized Ontario employees don't have full access to overtime pay 29%
  • of high-income employees don't have full access to overtime pay Sources: Workers' Action Centre, Statistics Canada Proposed solutions A recent report by the Workers' Action Centre makes a number of recommendations to rebuild the basic floor of rights for workers. The proposed reforms include: Amending the ESA to include protection from wrongful dismissal
  • Eliminating all occupational exemptions to ESA rights Repealing overtime exemptions and special rules Repealing overtime averaging provisions Repealing the emergency leave exemption for workplaces with less than 50 people Requiring employers to provide up to seven days of paid sick leave
Govind Rao

Private-medicine advocate voted head of doctors' group - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20150527|221342293

from heather Day private clinics privatization bc doctors

shared by Govind Rao on 27 May 15 - No Cached
  • Times Colonist (Victoria) Wed May 27 2015
  • B.C. Health Minister Terry Lake says he is seeking legal advice after a champion of private medicine who is locked in a legal battle with the province was elected Tuesday to represent the province's physicians next year. NDP health critic Judy Darcy, meanwhile, said she is flabbergasted at the vote, saying it's a serious problem if the minister can't meet with the doctors' representative because of a conflict. Dr. Brian Day was elected Tuesday by a single-vote margin as president-elect of Doctors of B.C. for 2015-16. He'll lead the organization for a year starting in June 2016.
  • Day, an orthopedic surgeon and co-owner of the private Cambie Surgery Centre in Vancouver, is involved in a court case against the B.C. government over private medicine. The lawsuit, which argues that it's unconstitutional to deny patients access to private clinics if waiting for care in the public health system harms their health, has been twice delayed and is not scheduled to be heard in B.C. Supreme Court until the end of the year. The case is expected to last seven months, which could mean Day presides over the organization at the same time that he's in court fighting the government - a scenario that could present numerous problems, since Doctors of B.C. interacts with the government frequently on joint committees and initiatives. "As minister of Health, I obviously want to have a positive relationship with the Doctors of B.C. - I've obviously had that with the past presidents," Lake said Tuesday.
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  • It may pose, I guess, potentially, some difficulties if we have an active legal case going forward whether I'm able to meet with the president-elect of the Doctors of B.C. I'll have to obviously seek [legal] opinion about that." Darcy questioned why the province's doctors would choose a champion of private medicine to represent their concerns to government. "Brian Day has led the charge to try and bring more private, for-profit health care to British Columbia," she said. "I know those are not values shared with the majority of B.C. doctors that I've spoken with."
  • Darcy said many doctors end up referring people to the private system, not because they believe in it but out of frustration. "We need to hear those voices loud and clear saying we need to be investing in innovation and improving wait lists in the public system. And that's the answer rather than moving to a private system." The current president, Victoria family physician Dr. Bill Cavers, will step down on June 6, to be replaced by Dr. Charles Webb until Day begins his term.
  • Cavers said the president's job is to represent the interests of all doctors. "It's not about your personal agenda. And if anyone has a reason to recuse themselves from board discussions, then they do that. Because sometimes interests do collide."
  • While the association does not support two-tier health care, Carvers said there is room for private care clinics to help relieve pressure on the public system, by providing elective day procedures, for example. "We believe the patient should get timely access to care and if they can't, then the government and/or health authority should provide some public funds so they can get access to care as a backstop, as a safety valve," Cavers said.
  • A total of 2,176 votes were cast Tuesday. Day was elected with 946 votes, while Dr. Alan Ruddiman received 945 votes. Dr. Lloyd Oppel was a third with 285 votes. ceharnett@timescolonist.com
  • Dr. Brian Day is the 2015-16 president- elect of Doctors of B.C. He will assume the position in June 2016.
Irene Jansen

Medecins Québécois pour un Regime Public. Two-Tier Radiology: Quebec's Creep... - 2 views

www.mqrp.qc.ca

doctors quebec coalition ally private clinics

shared by Irene Jansen on 19 Nov 12 - No Cached
  • Irene Jansen on 19 Nov 12
     
    Our 2012 annual report is now available in English The report shows: "While it has more material and human resources, Quebec is less effective than Canada as a whole in providing accessible medical imaging services. The exclusion from public coverage of CAT scan, MRI and ultrasound tests performed outside a hospital leads to joint public-private practice that has the effect of draining resources from the public to the private sector. This damaging distortion leads to problems of access to medical imaging for most patients…"  The report documents the inequitable, inefficient, costly and potentially unsafe utilization of medical imaging technology in Quebec's unique and highly privatized system.  One aspect, the relatively effective use of technology in hospitals compared to private clinics (which would be better yet if the system were entirely public), is clearly not limited to Quebec: "According to a 2008 study by Bercovici and Bell of public hospitals and private clinics offering MRIs in several provinces, including Quebec, the rate of use of machines is about 50% higher in hospitals than in private clinics: an average of 14.7 hours of operation per day during the week and 11.8 hours per day on weekends for hospital machines, compared to 9.7 hours per day during the week and 8.2 hours per day on weekends for machines in clinics." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645224/ The recommendations are also valuable information. 
Heather Farrow

Food in hospitals and prisons is terrible - but it doesn't have to be that way - The Gl... - 0 views

www.theglobeandmail.com/...article29951216

food hospital

shared by Heather Farrow on 11 May 16 - No Cached
  • Each Ontario hospital sets its own food budget, since the Ministry of Health and Long Term Care doesn’t give hospitals a cost guideline. North York General Hospital in uptown Toronto spends $4.46-million a year on food service: $1.66-million for food, plus $2.8-million for labour. The hospital says it had 144,165 “inpatient days” in 2014-15, which works out to $11.51 for food and $19.42 for labour, each day, per patient.
  • The hospital uses Steamplicity, a meal program by Compass, a global food service provider with annual sales of $31-billion. It’s one of the main providers of large-scale food service in Canada; its competitors include Sysco, Gordon Food Service, Aramark and Sodexo.Steamplicity meals are made in a production facility in Mississauga: food and water are put in “bespoke packaging” (it appears to be a plastic container) that has a valve designed to pop open when the internal temperature reaches 120 Celsius in a microwave. “The result is hot, delicious food, which retains its essential nutrients, where the flavour and texture of the food are preserved,” says Saira Husain, a spokeswoman for Compass.
  • “It sounds good, but is almost all frozen and quite highly processed,” says Joshna Maharaj, a chef and food advocate who has led changes in the kitchens at The Stop Community Food Centre, Ryerson University and the Hospital for Sick Children. “The biggest problem with frozen food is that it ends up quite watery, and everything is soft, one texture. Clinical.”From 2011 to 2012, Maharaj attempted to revolutionize the food at Scarborough General Hospital in east Toronto. Using grants from the province and the Greenbelt Fund, she bought ingredients from local farmers, changed the menu to reflect the community’s food culture (congee, jerk chicken) and trained the kitchen staff to cook from scratch.Sadly, the changes were all temporary. Scarborough General declined to say why it abandoned Maharaj’s program – she says the lunch tray, for example, cost just 33 cents more using her preferred ingredients – but the hospital no longer cooks food on site.
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  • She says she had greater success at Ryerson University, where she was hired to overhaul the food service from 2013 to 2015. “Ryerson was tremendous. We created a beautiful model and the students responded to it,” she says.Under her direction, staff stopped reheating soup from a bag and learned to cook from scratch with raw ingredients. “Soup easily became one of the most popular things on the campus,” she says. “Because it was good and made with thoughtfulness and not that much more work.”The big take-away for Maharaj was learning to negotiate with the companies that provide the food. “Working with a third-party operator is the undeniable piece you have to address when you’re talking about institutional food,” she says. “And these operators are the people we need to start talking to when we want change.”
  • “The vegetables are almost non-existent. They’ll throw a couple on the plate. You’ll have a spoonful of some nasty peas. And they’re not even green no more. They’re grey,” says Tom, who also says powdered mashed potatoes are served multiple times a week (“Both dehydrated and fresh potatoes are used in both the cook-chill and institutional kitchens,” Ross says.)Tom avoided eating chicken entirely when he was in jail. Another woman I spoke with, who spent a year at Vanier from 2010 to 2011, says the poultry was routinely served undercooked and pink. She says she relied on food purchased at the canteen, mostly ramen noodles. When dinner was “fish slop” – a dish she describes as “garbage with fish parts in it” – inmates would run to their stashes, softening the noodles with hot water from the sink over the toilet.
  • Compass employs half a million people around the world (including 30,000 in Canada), and supplies food to schools, offices, stadiums, museums, mining camps and offshore drilling platforms, as well as hospitals and correctional centres. Of the company’s many customers, patients and inmates have two things in common: First, they are unable to go buy themselves something more healthy, or at least more tasty; and second, we, the taxpayer, are responsible for feeding them.Last November, Compass took over food services at the Regina Correctional Centre, a move that saved the Saskatchewan government $2.4-million a year. Lacking a Yelp page, inmates went on a hunger strike in January to protest against the quality of the food. “If you don’t like the prison food, don’t go to prison,” Premier Brad Wall responded. In March, inmates refused food again, in part because Compass had raised prices at the canteen.Ontario spends $14.54 a day per inmate to feed about 8,000 prisoners in 26 correctional facilities, for a total of $41.3-million a year, including labour and transportation. The food cost is $9.17 for three meals. Perhaps inmates should not, per our punitive view of criminal justice, be dining on lamb racks and truffles. But it’s hard to imagine eating healthy on $9.17 a day.
  • Tom, a former prisoner introduced to me through the John Howard Society (which asked that I not use his last name), has served time at various correctional facilities around Ontario and suffers from diabetes and Crohn’s disease. He challenges Ross’s statement. “They don’t follow diets,” says Tom, who is in his 30s, was first locked up at the age of 12 and has spent more than 10 years behind bars. “Any jail food, you’re going to be on the toilet six times a day because what they’re giving you is running though you.”
  • In 2012, Paulette Padanyi, a now-retired faculty member of the University of Guelph, co-wrote a research paper called Food Provision in Ontario Hospitals and Long Term Care Facilities. Of the 55 hospitals studied, 19 hospital administrators agreed to discuss their food budgets. All of them outsourced the food production. Most told Padanyi that they took their cue from long-term-care facilities, which have a prescribed Ministry of Health and Long Term Care rate of $8.03 per day per patient to spend on food.In 2012, the average amount spent per patient in the hospitals Padanyi looked at was $7.91 a day. “They say to the contractors, ‘You’ve got x number of dollars, eight bucks a day per patient or whatever,’ effectively downloading the responsibility of meeting that budget,” she says.Often, these contracts are not just for patient meals, but the staffing and operation of food franchises within the hospital, plus housekeeping and custodial. The main conclusion of Padyani’s report was that food service is considered unimportant relative to the entire hospital.
  • May 10, 2016
  • For my entire life, my doctors, my parents and my government have sent me one clear message about food: Nutrition is a key component of physical and mental health. So I had assumed (and hoped) that if MDs or MPPs were choosing menus for those in their care, the result would be a 3-D version of the Canada’s Food Guide chart I coloured in elementary school.
Govind Rao

Island Health lining up deal for 55,000 day procedures; Contract with Calgary firm woul... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20150827|227964670

from heather bc private clinics privatization

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  • Times Colonist (Victoria) Thu Aug 27 2015
  • Island Health is hammering out a deal with a Calgary-based company to contract out up to 55,000 publicly funded day procedures to reduce wait-lists over the next three to five years. In coming weeks, the health authority aims to conclude contract negotiations with Surgical Centres Inc., which operates Nanaimo's Seafield Surgical Centre, as well as clinics in New Westminster, Regina, Saskatoon and Calgary.
  • Norm Peters, Island Health's executive director for surgical services, said the two sides are completing details for volumes of surgeries, types of procedures, location and timelines. "We are optimistic that we'll have something going in early 2016," Peters said Wednesday. Once the contract is signed and the space is leased, renovated and equipped, the facility must be accredited by the College of Physicians and Surgeons of B.C. In April, Island Health requested proposals for private clinics to provide up to 4,000 day surgeries - such as hip, knee, shoulder and hernia repairs, varicose vein procedures, and gall-bladder removals - each year over a three-to five-year contract for a maximum of 20,000 procedures.
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  • It was also looking for a private clinic to provide up to 4,000 colonoscopies on the south Island and up to 3,000 in the central Island each year over the same period, to a maximum of 35,000. The preferred lease site for the Victoria clinic is believed to be the five-storey professional office building in the new $100-million Eagle Creek Village.
  • The site, at Helmcken Road and Watkiss Way near Victoria General Hospital in View Royal, is being developed by Vancouverbased Omicron. Jessica Ng, Omicron's development manager, confirmed it's in negotiations with the Surgical Centres to lease out 15,000 square feet on the third floor of the professional office space. "Hopefully, they choose us as a preferred location," Ng said. The preferred site must meet the requirements of the College of Physicians and Surgeons of B.C. and be near a hospital for the convenience of patients, staff and doctors, Peters said.
  • "That does narrow it down to a few locations," he said. The proponent has confirmed the site would be ready to meet Island Health's timelines, Peters said. The B.C. Health Ministry, as outlined in a document called Future Directions for Surgical Services in B.C., is moving toward shifting appropriate publicly funded day surgeries to private clinics.
  • It is also exploring ways to allow stays of up to three days as part of a long-term strategy to manage wait-lists in the province. Overnight stays would require changes to the Hospital Act. Peters said overnight stays won't be part of this contract. "There is a desire provincially to look at that as a future stage, but that is not part of this initial contract with the preferred proponent." Island Health began awarding contracts for day surgeries to private clinics in 2004.
  • The NDP has said Island Health's call for contracts is an entrenchment of stop-gap measures where use of private clinics to reduce wait times drains funding, doctors and nurses from the public to the private system. "It's a worrisome trend," NDP critic Judy Darcy said when the plan to contract out was announced. She called the contract a short-term fix and just the tip of the iceberg in the move toward long-term privatization.
  • Peters said contracting out day procedures to private clinics saves Island Health millions in capital costs, reduces wait times for day surgeries, and opens up hospital operating room time for more complex surgeries. "This is not the privatization of health-care services," Peters said. "This is a benefit overall to not only those people waiting for surgery but it's a cost-effective way of delivering health care so we can invest in other areas." Of 541,885 publicly funded surgeries in B.C. in 2013-14, 5,503 were done in private facilities. ceharnett@timescolonist.com
Govind Rao

Sept 3 2014 Dr Day article - 0 views

www.fpinfomart.ca/...arrow_20140903_1406_ir7i_3.pdf

from heather Day private clinics privatization court bc

shared by Govind Rao on 03 Sep 14 - No Cached
  • Govind Rao on 03 Sep 14
     
    The Campbell River Citizens for Quality Health Care are warning people of what they say is a serious threat to our public health care system. The group said there is a dangerous legal attack on Canada's public health care system and it is going to court in September. Because most people in Canada have not heard anything about it, the group wants people to get the word out. Dr. Brian Day, a private clinic operator in Vancouver, wants the court to strike down the province's health-care law, which effectively bans clinics from billing patients for services already covered by the public system. Dr. Day claims that the defining principle at the heart of Canadian Medicare - that health services be provided according to patients' needs, not their ability to pay - is unconstitutional. His challenge will be heard in the BC Supreme Court starting Sept. 8 this year. Though the challenge is launched in B.C., it has the potential to bring USstyle care to Canadians across the country says the group. "Evidence shows that the kind of system Dr. Day is seeking would lead to longer wait times for care and poorer health for Canadians," said Edith MacHattie. Co-chair, BC Health Coalition Citizens for Quality Health Care want to make sure what they believe is a dangerous legal challenge is struck down.
Doug Allan

CIHI Survey: Alternative Level of Care in Canada: A Summary :: Longwoods.com - 1 views

www.longwoods.com/...20674

ALC

shared by Doug Allan on 10 Sep 13 - No Cached
  • Canadian health system managers are increasingly concerned about the number of hospital in-patients who do not need acute care services
  • These patients are widely known as "ALC patients" because they are awaiting an alternative level of care in a more appropriate setting.
  • This article summarizes more detailed findings presented in the recent report by the Canadian Institute for Health Information (CIHI 2009), Waiting in Hospital: Alternate Level of Care in Canada.
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  • In 2007-2008, 5% of hospitalizations (N = 74,504) and 14% of hospital days (N = 1.7 million) involved ALC patients. The provincial range for ALC hospitalizations was 2-7% of all hospitalizations (Figure 1).
  • LC patients were also more than twice as likely to have a comorbid condition as measured by the Charlson Comorbidity Index (Sundararajan et al. 2004). Dementia, as a main or comorbid diagnosis, accounted for almost one quarter of ALC hospitalizations and more than one third of ALC days.
  • Patients with dementia as a main diagnosis had a median ALC length of stay of 23 days compared with 10 days for ALC patients overall.
  • Total 26 4
  • Acute portion 11 4
  • ALC portion 10 -
  • Overall, the predominant discharge destination (43%) was to a long-term care facility (Figure 3).
  • More than one quarter of ALC patients were discharged home. Seventeen (17%) percent of these patients were readmitted to hospital within 30 days.
  • This compares to 12% for non-ALC patients discharged home.
  • Of the 12% who died during their ALC hospitalization, 42% were receiving palliative care and 45% were awaiting admission to another facility.
  • This issue of ALC is a sizeable challenge for hospitals and health system managers in Canada, with over 1.7 million hospital days used for ALC outside of Manitoba and Quebec in 2007-2008.
  • ALC patients were older and had diagnostic, comorbidity and length-of-stay profiles that indicate complex follow-up care requirements.
  • The reasons for provincial and facility variations in the number of ALC patients and days are not well understood.
  • However, ALC variation may also arise from differences in documentation and data collection.
  • Patient Pathway: Transfers from Continuing Care to Acute Care. found that new long-term care admissions accounted for most of the ALC waits for long-term care beds
  • Doug Allan on 10 Sep 13
     
    Patient Pathway: Transfers from Continuing Care to Acute Care. found that new long-term care admissions accounted for most of the ALC waits for long-term care beds
Govind Rao

'We have the evidence ... Why aren't we providing evidence-based care?'; Mental illness... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150523|221089241

from heather mental health privatization

shared by Govind Rao on 26 May 15 - No Cached
  • The Globe and Mail Sat May 23 2015
  • It's 4:30 on a Friday afternoon at her Sherbrooke, Que., clinic and Marie Hayes takes a deep breath before opening the door to her final patient of the day, who has arrived without an appointment. The 32-year-old mother immediately lists her complaints: She feels dizzy. She has abdominal pain. "It is always physical and always catastrophic," Dr. Hayes will later tell me. In the exam room, she runs through the standard checkup, pressing on the patient's abdomen, recording her symptoms, just as she has done almost every week for months. "There's something wrong with me," the patient says, with a look of panic. Dr. Hayes tries to reassure her, to no avail. In any case, the doctor has already reached her diagnosis: severe anxiety. Dr. Hayes prescribed medication during a previous visit, but the woman stopped taking it after two days because it made her nauseated and dizzy. She needs structured psychotherapy - a licensed therapist trained to bring her anxiety under control. But the wait list for public care is about a year, says Dr. Hayes, and the patient can't afford the cost of private sessions.
  • Meanwhile, the woman is paying a steep personal price: At home, she says, she spends most days in bed. She is managing to care for her two young children - for now - but her husband also suffers from anxiety, and the situation is far from ideal. Dr. Hayes does her best, spending a full hour trying to calm her down, and the woman is less agitated when she leaves. But the doctor knows she will be back next week. And that their meeting will go much the same as it did today. In its broad strokes, this is a scene that repeats itself in thousands of doctors' offices every day, right across the country. It is part and parcel of a system that denies patients the best scientific-based care, and comes with a massive price tag, to the economy, families and the health care system. Canadian physicians bill provincial governments $1-billion a year for "counselling and psychotherapy" - one third of which goes to family doctors - a service many of them acknowledge they are not best suited to provide, and that doesn't come close to covering patient need. Meanwhile, psychologists and social workers are largely left out of the publicly funded health-care system, their expertise available only to Canadians with the resources to pay for them.
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  • Imagine if a Canadian diagnosed with cancer were told she could receive chemotherapy paid for by the health-care system, but would have to cough up the cash herself if she needed radiation. Or that she could have a few weeks of treatment, and then be sent home even if she needed more. That would never fly. If doctors, say, find a tumour in a patient's colon, the government kicks in and offers the mainstream treatment that is most effective. But for many Canadians diagnosed with a mental illness, the prescription is very different. The treatment they receive, and how much of it they get, will largely be decided not on evidence-based best practices but on their employment benefits and income level: Those who can afford it pay for it privately. Those who cannot are stuck on long wait lists, or have to fall back on prescription medications. Or get no help at all. But according to a large and growing body of research, psychotherapy is not simply a nice-to-have option; it should be a front-line treatment, particularly for the two most costly mental illnesses in Canada: anxiety and depression - which also constitute more than 80 per cent of all psychiatric diagnoses.
  • Why aren't we providing evidence-based care?" .. The case for psychotherapy Research has found that psychotherapy is as effective as medication - and in some cases works better. It also often does a better job of preventing or forestalling relapse, reducing doctor's appointments and emergency-room visits, and making it more cost-effective in the long run.
  • Therapy works, researchers say, because it engages the mind of the patient, requires active participation in treatment, and specifically targets the social and stress-related factors that contribute to poor mental health. There are a variety of therapies, but the evidence is strongest for cognitive behavioural therapy - an approach that focuses on changing negative thinking - in large part because CBT, which is timelimited and very structured, lends itself to clinical trials. (Similar support exists for interpersonal therapy, and it is emerging for mindfulness, with researchers trying to find out what works best for which disorders.) Research into the efficacy of therapy is increasing, but there is less of it overall than for drugs - as therapy doesn't have the advantage of well-heeled Big Pharma benefactors. In 2013, a team of European researchers collated the results of 67 studies comparing drugs to therapy; after adjusting for dropouts, there was no significant difference between the most often-used drugs - selective serotonin reuptake inhibitors (SSRIs) - and psychotherapy.
  • The issue is not one against the other," says Montreal psychiatrist Alain Lesage, director of research at the Douglas Mental Health University Institute. "I am a physician; whatever works, I am good. We know that when patients prefer one to another, they do better if they have choice." Several studies have backed up that notion. Many patients are reluctant to take medication for fear of side effects and the possibility of difficult withdrawal; research shows that more than half of patients receiving medication stop taking it after six months. A small collection of recent studies has found that therapy can cause changes in the brain similar to those brought about by medication. In people with depression, for instance, the amygdala (located deep within the brain, it processes basic memories and controls our instinctive fight-or-flight reaction) works in overdrive, while the prefrontal cortex (which regulates rational thought) is sluggish. Research shows that antidepressants calm the amygdala; therapy does the same, though to a lesser extent.
  • But psychotherapy also appears to tune up the prefrontal cortex more than does medication. This is why, researchers believe, therapy works especially well in preventing relapse - an important benefit, since extending the time between acute episodes of illnesses prevents them from becoming chronic and more debilitating. The theory, then, is that psychotherapy does a better job of helping patients consciously cope with their unconscious responses to stress.
  • According to treatment guidelines by leading international professional and scientific organizations - including Canada's own expert panel, the Canadian Network for Mood and Anxiety Treatments - psychotherapy should be considered as a first option in treatment, alone or in combination with medication. And it is "highly recommended" in maintaining recovery in the long term. Britain's independent, research-guided scientific body, the National Institute for Health and Care Excellence, has concluded that therapy should be tried before drugs in mild to moderate cases of depression and anxiety - a finding that led to the creation of a $760million public system, which now handles therapy referrals for nearly one million people a year.
  • In 2012, Canada's Mental Health Commission estimated that only about one in three adults and one in four children are receiving support and treatment when they need it. Ironically, anti-stigma campaigns designed to help people understand mental illness may only make those statistics worse. In Toronto, for instance, putting up posters in subway stations in 2010 had the unexpected effect of spiking the volume of walk-ins at nearby emergency rooms by as much as 45 per cent in 12 months. Dr. Kurdyak treated many of them at CAMH. The system, he says, "has been conveniently ignoring this unmet need. It functions as if two-thirds of the people suffering won't get help." What would happen if the healthcare system outright "ignored" two-third of tumour diagnoses?
  • Essentially, argues Dr. Lesage, adding therapy into the health-care system is like putting a new, highly effective drug on the table for doctors. "Think about it," he says. "We have a new antidepressant. It works as well as many others, and it may even have some advantages - it works better for remission - with fewer side effects. The patients may prefer it. And [in the long run] it doesn't cost more than what we have. How can it not be covered?" ..
  • A heavy price This isn't just a medical issue; it's an economic one. Mental illness accounts for roughly 50 per cent of family doctors' time, and more hospital-bed days than cancer. Nearly four million Canadians have a mood disorder: more than all cases of diabetes (2.2 million) and heart disease (1.4 million) combined.
  • Mental illness - and depression, in particular - is the leading cause of disability, accounting for 30 per cent of workplace-insurance claims, and 70 per cent of total compensation costs. In 2012, an Ontario study calculated that the burden of mental illness and addiction was 1.5 times that of all cancers, and more than seven times the cost of all infectious diseases. Mental illness is so debilitating because, unlike physical ailments, it often takes root in adolescence and peaks among Canadians in their 20s and 30s, just as they are heading into higher education, or building careers and families. Untreated, symptoms reverberate through all aspects of life, routinely trapping people in poverty and homelessness. More than one-third of Ontario residents receiving social assistance have a mental illness. The cost to society is clearly immense.
  • Yet, when family doctors were asked why they didn't refer more patients to therapy in a 2008 Canadian survey, the main reason they gave was cost. For many Canadians, private therapy is a luxury, especially if families are already wrestling with the economic fallout from mental illness. Costs vary across provinces, but psychologists in private practice may charge more than $200 an hour in major centres. And it's not just the uninsured who are affected.
  • Although about 60 per cent of Canadians have some form of private insurance, the amount available for therapy may cover only a handful of sessions. Those with the best benefits are more likely to be higherincome workers with stable employment. Federal public servants, notably, have one of the best plans in the country - their benefits were doubled in 2014 to $2,000 annually for psychotherapy. Many of those who can pay for therapy are doing so: A 2013 consultant's study commissioned by the Canadian Psychological Association found that $950-million is spent annually on private-practice psychologists by Canadians, insurance companies and workers compensation boards. The CPA estimates t
  • These are the patients that family doctors juggle, the ones who eat up appointment time, and never seem to get better, the ones caught on waiting lists. Sometimes, they have already been bounced in and out of the system, received little help, and have become wary of trying again. A 40-something mother recovering from breast cancer, suffering from chronic depression post-treatment, debilitated by fear her cancer will return. A university student, struggling with anxiety, who hasn't been to class for three weeks and may soon be kicked out of school. A teenager with bulimia removed from an eatingdisorder program because she couldn't follow the rules. They are the ones dangling on waiting lists in the public system for what often amounts to a handful of talk-therapy sessions, who don't have the money to pay for private therapy, or have too little coverage to get the full course of appointments they need.
  • Canada's investment does not match that burden. Only about 7 per cent of health-care spending goes to mental health. Even recent increases pale when compared to other countries: According to a study by the Canadian Mental Health Association, Canada increased per-capita funding by $5.22 in 2011. The British government, meanwhile, kicked in an extra 12 times that amount per citizen, and Australia added nearly 20 times as much as we did. Falling off a cliff, again and again
  • In Winnipeg, Dr. Stanley Szajkowski watched for months as his patient, a woman in her 80s, slowly declined. Her husband had died and she was spiralling into a severe depression. At every appointment, she looked thinner, more dishevelled. She wasn't sleeping, she admitted, often through tears. Sometimes she thought of suicide. She lived alone, with no family nearby, and no resources of her own to pay for therapy. "You do what you can," says Dr. Szajkowksi. "You provide some support and encouragement." He did his best, but he always had other patients waiting.
  • hat 30 per cent of private patients pay out-ofpocket themselves. When the afflicted don't seek help, the cost isn't restricted to their own pocketbook. People with mental-health problems are significantly more likely to abuse drugs and alcohol, and to become physically sick, further increasing health-care costs. A 2014 study by Oxford University researchers found that having a mental illness reduced life expectancy by 10 to 20 years, roughly the same as did smoking and obesity. A 2008 Statistics Canada study linked depression to new-onset heart disease in the general population. A 2014 U.S. study found that women under the age of 55 are twice as likely to suffer or die from a heart attack, or require heart surgery, if they have moderate to severe depression. The result: clogged-up doctors' offices, ERs, and operating rooms. And an inexorable burden for the patients' families forced to fill the gaps in caregiving - or carry on when they lose a loved one.
  • Patients refer to it as falling repeatedly off a cliff. And they can only manage the climb back up so many times. Family doctors interviewed for this story admitted that they are often "handholding" patients with nowhere else to go. "I am making them feel cared for, I am providing a supportive ear that they may not get anywhere else," says Dr. Batya Grundland, a physician who has been in family practice at Toronto's Women's College Hospital for almost a decade. "But do I think I am moving them forward with regard to their illness, and helping them cope better? I am going to say rarely." More senior doctors have told her that once in a while "a light bulb goes off" for the patients, but often only after many years. That's not an efficient use of health dollars, she points out - not when there are trained therapists who could do the job better. However, she says, "in some cases, I may be the only person they have."
  • Family doctors aren't the only ones struggling to find therapy for their patients. "I do a hundred consultations a year," says clinical psychiatrist Joel Paris, a professor at McGill University and research associate at the Montreal Jewish General, "and one of the most common situations is that the patient has tried a few anti-depressants, they have not responded very well, and from their story it is obvious they would benefit from psychotherapy. But where do they go? We have community clinics here in Montreal with six-to-12-month waiting lists even for brief therapy." A fractured, inefficient system
  • "You fall into the role that is handed to you," says Antoine Gagnon, a family doctor in Osgoode, on the outskirts of Ottawa. He tries to set aside 20-minute appointments before lunch or at the end of the day to provide "active listening" to his patients with anxiety and depression. Many of them are farmers or self-employed, without any private coverage for therapy. "Five of those minutes are spent talking about the weather," he says, "and then maybe you get into the meat of the problem, but the reality is we don't have the appropriate amount of time to give to therapy, even to listen, really." Often, he watches his patients' symptoms worsen over several months, until they meet the threshold of a clinical diagnosis. "The whole system could save on productivity and money if people were actually able to get the treatment they needed."
  • But these issues aren't insurmountable, as other countries have demonstrated. Britain, for instance, has trained thousands of university graduates to become therapists in its new public program, following research showing that, as long they have the proper skills, people don't need PhDs to be effective therapists. Australia, which has created a pay-for-service system, also makes wide use of online support to cost-effectively reach remote communities.
  • Except for a small fraction of GPs who specialize in psychotherapy, few family doctors have the training - or the time - to provide structured therapy. Saadia Hameed, a GP in a family-health team in London, Ont., has been researching access to psychotherapy for an advanced degree. Many of the doctors she has interviewed had trouble even producing a clear definition of therapy. One told her, "If a patient cries, than it's psychotherapy." Another described it as "listening to their woes." A 2007 survey of 163 family doctors in Ontario found that almost four out of five had not received training in cognitive behavioural therapy, and knew little about it. "Do family doctors really need to do that much psychotherapy," Dr. Hameed asks, "when there are other people trained - and better trained - to do it?"
  • What further frustrates treatment for physicians and patients is lack of access to specialists within the system. Across the country, family doctors describe the difficulty of reaching a psychiatrist to consult on a diagnosis or followup with their patients. In a telling 2011 study, published in the Canadian Journal of Psychiatry, researchers conducted a real-world experiment to see how easily a GP could locate a psychiatrist willing to see a patient with depression. Researchers called 297 psychiatrists in Vancouver, and reached 230. Of the 70 who said they would consider taking referrals, 64 required extensive written documentation, and could not give a wait-time estimate. Only six were willing to take the patient "immediately," but even then, their wait times ranged from four to 55 days. Psychiatrists are in increasingly short supply in Canada, and there's strong evidence that we're not making the best use of these highly trained specialists. They can - and often do - provide fee-for-service psychotherapy in a private setting, which limits their ability to meet the huge demand to consult with family doctors and treat the most severe cases.
  • A recent Ontario study by a team at CAMH found that while waiting lists exist in both urban and rural centres, the practices of psychiatrists in those locations tend to look very different. Among full-time psychiatrists in Toronto, 10 per cent saw fewer than 40 patients, and 40 per cent saw fewer than 100 - on average, their practices were half the size of psychiatrists in smaller centres. The patients for those urban psychiatrists with the smallest practices were also more likely to fall in the highest income bracket, and less likely to have been previously hospitalized for a mental illness than those in the smaller centres.
  • And those therapy sessions are being billed with no monitoring from a health-care system already scrimping on dollars, yet spending a lot on this care: On average, psychiatrists earn $216,000 a year. There is nothing to stop psychiatrists from seeing the same patients for years, and no system to ensure the patients with the greatest need get priority. In Australia, Britain and the United States, by contrast, billing for psychiatrists has been adjusted to encourage them to reduce psychotherapy sessions and serve more as consultants, particularly for the most severe cases, as other specialists do.
  • As the Canadian system exists now, says Benoit Mulsant, the physician-in-chief at CAMH and also a psychiatrist, the doctors in his specialty "can do whatever they please. If I wanted, I could have a roster of actor patients who tell me entertaining stories, and I would be paid the same as someone who is treating homeless people. ... By treating the rich and famous, there is zero risk of being punched in the face by a patient." Left out in all this, by and large, are other professionals who can provide therapy. It doesn't help that the rules are often murky around who can call themselves psychotherapists. While psychologists and social workers are licensed under their professional associations, in some provinces a person can call himself a marriage counsellor or music therapist with no one demanding they be certified. In 2007, Ontario passed a law to regulate psychotherapists, requiring them to register with a provincial college that would set standards and handle complaints. Currently, however, the law is in limbo, although the government has said it will finally bring it into force by December. The brain keeps many secrets
  • Science, however, has yet to find depression's equivalent of insulin. Despite being scanned, poked and stimulated over and over and over again, the brain keeps its secrets. The "chemical imbalance" theory is now viewed as simplistic at best. It may not do much for patients, either: A 2014 study published in the journal Behaviour Research and Therapy suggested that, rather than reassuring them, focusing on the biological explanation for depression actually made patients feel more pessimistic and lacking in control. SSRIs work by increasing the amount of serotonin, a chemical that helps deliver messages within the brain and is known to influence mood. But researchers aren't sure why the drugs help some patients and fail with others. "Basically, it's like we have a bucket of water and we pour it over the patient's head," says Dr. Georg Northoff, the University of Ottawa's Michael Smith chair of Neurosciences and Mental Health. "But you want a drug that injects the water in a very specific brain regions or brain system, which we don't have."
  • Critics of therapy have argued that it's basically "good listening" - comparable to having a sympathetic friend across the kitchen table - and that in the real world of mercurial patients and practitioners of varying abilities, a pill just works better. That's true in many cases, especially when the symptoms are severe and the patients is suicidal: a fast-acting medication is safer, and may even be necessary before starting talk therapy. The staunchest advocates of therapy do not suggest it should be the first course of treatment for psychosis, or debilitating chronic depression, or mania - although, in those cases, there is evidence that psychotherapy and medication work well in tandem. (A 2011 meta-analysis found that patients with severe depression who received a combination approach had higher recovery rates and were less likely to drop out of treatment.) But drugs also don't work as well as the manufacturers would like us to think. Roughly one-third of patients given a drug will see no benefit (although they often respond to a second or third medication). In randomly controlled trials, drugs often perform only marginally better than sugar pills.
  • Yet it's talk therapy that the public often views most skeptically. "Until you go to a therapist, or a member of your family has a serious psychological problem, people are unsympathetic [about therapy]," says Dr. Paris, the Montreal psychiatrist. "They are very skeptical, and they don't believe the research. It's amazing, because pharmaceutical trials will get approval for a drug on the basis of two clinical trials that they paid for. And we have 100 clinical trials and no one believes us."
  • Dr. Ajantha Jayabarathan, an assistant professor at Dalhousie University's medical school, spent her early years as a family doctor in Spryfield, N.S., trying to manage an overload of mental-health cases. Most of her patients had little insurance; there was one reduced-cost counselling service in town, but the waiting lists were long. In 2000, her group practice became a test site for a shared-care project, which gave the doctors access to a mental-health team, including weekly in-person consultations with a psychiatrist. "It was transformative," she says. "We looked after everything in-house.
  • Over time, Dr. Jayabarathan says, she learned how to properly assess mental illness in patients, and how to use medication more effectively. "I just made it my business to teach myself what to do." It's the kind of workaround GPs are increasingly experimenting with, waiting for the system to catch up. Who would pay - and how?
  • The case for expanding publicly funded access to therapy is gaining traction in Canada. In 2012, the health commissioner of Quebec recommended therapy be covered by the province; it is now being studied by Quebec's science-based health body (INESSS), which is expected to report back next year. A new Quebec-based organization of doctors, researchers and mental-health advocates called the Coalition for Access to Psychotherapy (CAP) is lobbying the government.
  • In Manitoba, the Liberal Party - albeit well behind in the polls - has made the public funding of psychologists one of its campaign platforms for the province's spring 2016 election. In Saskatchewan, the government commissioned, and has since endorsed, a mental-health action plan that includes providing online therapy - though politicians have given themselves 10 years to accomplish it. Michael Kirby, the former head of the Canadian Mental Health Commission, has been advocating for eight annual sessions of therapy to be covered for children and youth in need.
  • There are significant hurdles: Which practitioners would provide therapy, and how would they be paid? What therapies would be covered, and for how long? Complicating every aspect of major mentalhealth change in Canada is the question of who should shoulder the cost: the provinces or Ottawa. In a written statement in response to questions from The Globe and Mail, federal Health Minister Rona Ambrose lobbed the issue back at her provincial counterparts, pointing out that the Canada Health Act does not "preclude provinces and territories from extending public coverage to other services or providers such as psychologists."
  • One result can be overloaded family doctors minimizing mental-health problems. "If you have nothing to offer someone," asks Dr. Anderson, "how much are you going to dig around to find out what is going on?" Some doctors also admit that the lack of resources can lead to physicians cherry-picking patients who don't have mental illness. And yet family physicians alone bill about $361million a year for counselling or psychotherapy in Canada - 5.6 million visits of roughly 30 minutes each. This is a broad category, and not always specifically related to mental health (some of it includes drug counselling, and a certain amount of coaching is a necessary part of the patient-doctor relationship). When it is psychotherapy, however, doctors admit it's often more supportive listening than actual therapy.
  • So how would Canada pay for access to such therapy? It wouldn't be cheap, in the short term. The savings would come from what Canadians would not have to spend in the long term: in additional medical and drug costs, emergency-room visits and hospital stays, and in unnecessary disability payments, to say nothing of better long-term health outcomes for patients given good care earlier. Some of the figures being tossed around sound staggering. Rolling out a version of Britain's centre-based program across Canada would cost $950-million. Michael Kirby's plan would amount to $1,000 annually per patient. A 2013 report commissioned by the Canadian Psychological Association calculated that, based on predicted need, and assuming no coverage from private health-care plans, providing an average of six sessions of therapy a year would cost an estimated $2.8-billion annually.
  • But any of those figures would still be a fraction of the roughly $210-billion that Canada spends annually on health care. Figuring out how to make the system most costeffective is, according to sources, currently delaying the INESSS report to the Quebec government. "You need to facilitate the government," says Helen- Maria Vasiliadis, a professor of community health at the University of Sherbrooke. "You can't be going to policymakers and showing them billions and billions of dollars. People start having heart attacks. With evidence in hand, we have to present possible solutions."
  • An insurance-based plan is the proposal that has emerged from the Quebec-based CAP group, which sent its proposal to Quebec's health minister last month. In its design, the system would work much like Quebec's public drug plan - Quebeckers not covered through work plans would contribute to a provincial insurance program for therapy. That would be similar to the system that Germany has used for decades. One step forward, one step back
  • Last year, the Sherbrooke clinic where Marie Hayes works received provincial funding for a part-time psychologist and a full-time social worker. With a roster of 25,000 patients, the clinic team laid out clear guidelines for the psychologist, who would consult on cases and screen patients, and be limited to a mere four sessions of actual counselling with any one patient. "We wanted to be careful she didn't become a waiting list - like everything in the system," says Dr. Hayes. The social worker helps guide patients into services such as housing and addiction counselling. They have also offered group sessions for depression management at the clinic. As stretched as those new professionals are in such a large practice, Dr. Hayes says the addition of that mental-health team is improving the care she can provide patients. Recently, for instance, the 32- year-old mother with anxiety attended sessions with the psychologist. "She is making progress," says Dr. Hayes, "slowly."
  • At Women's College Hospital in Toronto, Dr. Grundland is not so lucky. Asked to describe a difficult case, the family-practice physician mentions a patient suffering from depression after a lifechanging accident. Every month, doctor and patient would repeat the same conversation they'd already had more than a dozen times - and make little real headway. Her patient, says Dr. Grundland, needs a trained therapist: someone she can see regularly, to help her move past her frustration, counsel her about addiction, and ease the burden on her family.
  • But there's no extra money in the patient's budget for a psychologist. "I do my best," Dr. Grundland says, "but it's not my area of expertise." Meanwhile, the patient isn't getting better, and in the time that it takes to make it through one appointment with her, Dr. Grundland could see three other people with problems she was actually trained to treat. "But," says Dr. Grundland, "she has nowhere else to go." Erin Anderssen is a feature writer at The Globe and Mail. OPEN MINDS How to build a better mental health care system
  • The Centre for Addiction and Mental Health has purchased advertisements to accompany this series. While CAMH professionals are quoted in this story, the organization had no involvement in the creation or production of this, or any other story in the series. $20.7-billion The cost, according to a 2012 Conference Board of Canada report, of lost productivity each year due to mental illness. What else does $20-billion represent?
  • $20B: Canadian spending on national defence, 2012-13 $20B: Market valuation of Airbnb, 2015 $21B: Kitchener-CambridgeWaterloo region's GDP, 2009 $21B: Amount food manufacturing contributed to the economy, 2012
Govind Rao

Health authority weighs bids from three private clinics - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20150610|222403632

from heather private clinics privatization bc surgery legislation

shared by Govind Rao on 23 Jun 15 - No Cached
  • Times Colonist (Victoria) Wed Jun 10 2015
  • Island Health is evaluating proposals from three private clinics as it works toward contracting out up to 55,000 publicly funded day procedures over the next three to five years - the health authority's largest and longest contract yet to reduce wait times. Once the contract or contracts are awarded, Island Health could be the leader in using private clinics for publicly funded day surgeries in the province. "We're looking at doing things differently and if we're out ahead and this is a success, I hope other jurisdictions follow us," said Suzanne Germain, spokeswoman for Island Health. By the May 29 deadline, Island Health had received three responses to its April request for proposals. Island Health wants private clinics to provide up to 4,000 day surgeries - everything from knee and hernia repairs to gallbladder removals - each year over a three-to five-year contract for a maximum of 20,000 procedures. Island Health is
  • also looking for a private clinic or clinics to provide up to 4,000 endoscopic procedures - colonoscopies - on the south Island and up to 3,000 endoscopies in the central Island each year over the same period for a maximum of 35,000.
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  • Norm Peters, Island Health's executive director for surgical services, estimates it will take six to eight weeks to evaluate the proposals, choose one or more preferred proponents and hammer out agreements. "We're just in the start of the review stage," Peters said.
  • Depending on what's proposed, Island Health could be awarding one contract to a single company or two contracts to different companies on the south and central Island. B.C. Health Minister Terry Lake said the use of private clinics for publicly funded day procedures is strengthening the public system by increasing the number of more complex surgeries that can be carried out in hospitals.
  • Of 541,885 publicly funded surgeries in B.C. in 2013-14, 5,503 were done in private facilities. In 2013-14, Island Health funded 160 day surgical procedures to be performed in private clinics. That was less than the previous year when Island Health contracted out 511 publicly funded procedures for adults to private clinics and 31 for children for a total of 542.
  • Interior Health contracted out the most publicly funded day surgeries in 2013-14 to private facilities - 2,053 adult procedures and 173 pediatric procedures for a total of 2,226. If Island Health goes on to fund a maximum of 10,000 procedures annually over the next five years through private clinics, the health authority will lead the province in doing so.
  • Peters said with more day surgeries, such as varicose vein procedures, being performed by private clinics, more capacity is created in hospitals to perform hip and knee procedures, which also have long wait-lists. Edition: Final
Govind Rao

Hospital re-admission rates debated - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|pgsf|20151008|230920202

from heather Ontario cupe hospital readmissions campaign rural cuts

shared by Govind Rao on 08 Oct 15 - No Cached
  • Smiths Falls EMC Thu Oct 8 2015
  • A union representing employees at the Perth and Smiths Falls District Hospital (PSFDH) is charging that re-admission rates have risen 16.5 per cent over the past several years. Hospital management, however, is disputing this, pegging the number much lower, at about seven per cent. During a press conference at the Smiths Falls branch of the Royal Canadian Legion on Tuesday, Sept. 29, Michael Hurley, president of the Ontario Council of Hospital Unions (OCHU), said that their statistics were drawn from information stretching from 2009 to 2014 from the Canadian Institute for Health Information, and focused specifically on the PSFDH but also the Brockville General Hospital too.
  • "A re-admission is a system failure," said Hurley. "People who were discharged were coming back in...in significant numbers." John Jackson, president of CUPE (Canadian Union of Public Employees) local 2119, who works at the Perth and Smiths Falls District Hospital, agreed.
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  • "Where beds have been cut in the community, there has been a spike in re-admission rates," said Jackson. His own hospital saw 12 beds, six at each site, cut back in 2013. "I can't speak about individual cases," he added, but Mike Rodrigues, vice president of CUPE local 1974, who works at the Kingston General Hospital (KGH), has seen, first-hand, patients being sent home to free up beds at his workplace. "There are two huddles a day," said Rodrigues, where upper management and the hospital's chief executive officer confer at 9:15 a.m. and 2:15 p.m. to discuss "Who can go today? Who can we get out?" when there is "gridlock," at the hospital, such as long waiting room times. "It's difficult," Rodrigues said. But, "you tow the party line. They do what they are told."
  • He conceded that the doctors and nurses likely do a triage of who is best able, of all of the patients on the floor, to go home, but he has seen, in the last 10 years alone, women being sent home 10 to 12 hours after giving birth to a child, whereas, in 2005, that mother could have stayed three to four days in the hospital. Hurley said he has heard of patients who "are not well enough to be sent home...fighting with their doctors," who are trying to discharge them. "A lot of pressure is put on the family," from the hospital administration and doctors, Hurley added, with the hospital threatening to charge families as much as $300 to $1,000 a day for each additional day their loved one remains in hospital - something he says is illegal. He saw such a scenario with his own mother.
  • "She can't stay here," he was told. "'What're you going to do with her?' She died in hospital." Very often, according to Hurley, a patient may acquire a hospital-borne virus while recovering from a surgery, but "people are being moved through the system much more quickly," than they used to be, sometimes without sufficient recovery periods, and then, "the system has a second go at making them better." But this not only causes distress for the family and the health system, but also in the workforce too. "A huge number of people in Ontario do not have paid sick leave," said Hurley. "The personal cost to me (as a returning patient) is significant...It's a health setback, it's a psychological setback."
  • Hurley added that hospitals in both Kingston and Ottawa were experiencing similar re-admission rates. He added that he did not think that it was "entirely valid," to dismiss re-admission rates on the rising number of older people in the area, as Baby Boomers reach their retirement years. "They will try to downplay this," said Hurley, before adding that it was not a problem created at the Smiths Falls or Perth hospital sites themselves. "This is a system problem because they have been starved of funding." As for blaming the issue on the elderly, Hurley said that that was ageism.
  • Jackson lamented that while the hospital administration has tried its best to be as kind as it can with its cuts - with only one outright layoff - getting 12 beds cut from the local hospital system seems to be "how you get rewarded for efficiency." "It's time for the province to start funding the hospitals properly," said Hurley. One way that this could be addressed would be to raise the corporate tax rate. Administration response Later that week, in her office at the Great War Memorial Hospital site of the Perth and Smiths Falls District Hospital, president and chief administrative officer Bev McFarlane held a mini press conference of her own, alongside board chair Richard Schooley, to refute some of the union's allegations, starting with some of their numbers. "There is often another aspect of re-admissions," said Schooley during the interview on Thursday, Oct. 1. A patient could be, theoretically, discharged from hospital after recovering from heart surgery, then be re-admitted two weeks later after falling on some ice while shoveling snow from his driveway. Any admission to hospital within 30 days after a discharge would be counted as a re-admission - even if the cause was not directly related to the initial admission.
  • She hastened to add that her hospital was recently awarded the distinction of being one of the top five hospitals in the province for quick-time responses, for getting patients seen to and into an in-patient bed. According to the hospital's numbers, the occupancy rate for acute care hospital beds was as low as the high 60s per cent over the summer, and in the high 70s per cent this past spring. "You have to look at all of the other indicators," said Mc-Farlane. Schooley also noted that the hospital's admissions have gone up from more than 31,000 in 2009 to more than 37,000 in 2014-15, and that they estimate the real re-admission rate at about seven per cent.
  • How can you deal with more admissions with fewer beds?" asked McFarlane. "We are able to make you feel better in a shorter period of time." Gall bladder surgery used to require a seven-day stay in hospital, she said. Now, it is considered day surgery. "You aren't even admitted," she said. "The business of hospital care has changed over the years. The worst thing you can do is keep someone in an acute care bed when they don't need to be there." As for charging patients who refuse to leave the hospital because they do not believe that they are fully healed yet, Mc-Farlane did admit that "there is a rate that is charged, if there is a reasonable discharge plan and people refuse to leave," but she added that "I don't think we've ever done that here."
  • As for the union's assertion that the hospital had less money on hand, Schooley pointed out that gross hospital revenues rose from $43 million in 2010 to $51 million in 2015. In fact, the LHIN is giving the hospital more money as a type of efficiency bonus, having wrestled five years worth of deficits into a $1.2 million surplus in 2014, with a projected surplus of $1.6 million for 2015. "That's the cushion we are building," said Schooley, in anticipation of the LHIN providing them with less money in the coming years. "In case some of these funding change realities manifest themselves."
  • We have seen increases in our LHIN and Ministry of Health funding," added Schooley.
Govind Rao

Our son deserved better treatment - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|sjet|20150526|221272048

from heather NL quality

shared by Govind Rao on 26 May 15 - No Cached
  • The Telegram (St. John's) Tue May 26 2015
  • Being the parent of a special needs child offers unique challenges on a daily basis, be it challenges from your child's needs, challenges on your marriage, challenges with government or challenges from other people either knowing of your situation or being ignorant of it. I've seen people give me that look when Nicholas is having a tantrum at a restaurant, the "what kind of a parent are you, will you control your child?" look. But I've also seen the smiles on people's faces when he's doing something silly in public, bouncing through the mall on my shoulders or kicking water in a puddle. However, our most recent experience was with people who knew our situation, but I believe the word ignorant could be used to describe them as well.
  • Just to provide some background, our little Nicholas was born in 2010, a perfect little boy, 10 fingers, 10 toes, no health issues, and he slept for 12 hours a night almost from the start. A glorious, amazing, wonderful, funny little guy, which in spite of all of the challenges we have faced since his epilepsy and autism diagnosis, hasn't changed. He has endured so much poking and prodding, countless EEGs, MRIs, blood tests, biopsies and spinal taps, and always bounced back with a smile as if it was "normal." As a parent, you would do anything to help your child, to make him better, to try to give him the best life possible. My wife gave up any thoughts of a career because our son needed 24-hour care during all of this. We've tried seven "traditional" epilepsy medications, naturopathic medications and special diets. We've paid for a trip to SickKids Hospital in Toronto and therapists out of our own pocket, while we were on the two-year wait list for government support. And we've interviewed and hired several different applied behaviour analysis workers to assist in his development.
  • ...5 more annotations...
  • It's been a long couple of years, but recently after switching to a gluten-free diet and developing a program of naturopathic supplements, we've seen some improvement, going from multiple seizures a day to multiple days without seizures, and Nicholas's development exploded during this time: new words and tasks mastered almost every day with the decrease in seizure activity. We found a daycare for a few hours a day, a few days a week, to help Nicholas socialize and aid in his development. He loved going to school and being with his friends and his teacher, and he learned many new things while there. He was developing so well there that we were going to admit him for full days this summer and enroll him in kindergarten at this facility next year because we felt this learning environment was the best for his needs.
  • After two long years we were starting to achieve some normalcy in our lives. Nicholas was functioning well, playing with his friends and was rehearsing for his first concert. Maybe my wife could even look at starting some kind of a career again. Recently, things changed. The ignorance and insensitivity of some people came to light. After picking up Nicholas from school, my wife received a phone call saying that they could no longer accommodate Nicholas's needs. There was no place for him to safely take a nap after having a seizure, and we would need to come pick him up after he had one. After six months of attending this school, now all of a sudden he could no longer be accommodated. The reasoning they gave us didn't make sense - a book could fall on his head while he's asleep, and if he needs to sleep then we feel it is best he did this at home.
  • After arranging a meeting with the owner of this "educational facility" we were just given the runaround about why Nicholas's seizures were suddenly an issue. We were given a sales pitch about how it was the owner's dream to open this facility, and her love of teaching children, and even though this is a for-profit institution she does not make money as she puts it all back into the school. There was still no real reason as to why she could no longer accommodate my son other than the fact that there was nowhere for him to safely sleep after a seizure, in a daycare that has cots and multiple classrooms and offices, and Nicholas has a government funded one-on-one assistant. After more questions about inclusion and having to accommodate special needs people, the answer that was given, that has been bouncing around my brain all week, was "we are a private institution and we don't have to take in anybody."
  • So there it is, the bottom line answer - all of the love for children and teaching them seems to be as long as your child is perfect and you have the money to pay. If you have to be "accommodated," then it's not worth the effort. So the joy and adulation of seeing our son begin to grow, of watching him in his concert, of having a chance at being "normal," was shattered because it was too much trouble to accommodate his needs.
  • We were never given the real reason, did a staff member complain? Did another parent complain? Is there a "normal" kid that is looking for Nicholas's slot who would be less trouble to accommodate? We may never know the real answer. But that's OK. After a few days to recover and clear our heads, we are determined that things will work out. We've worked hard, in particular my wife has worked hard, in the last two years to give Nicholas everything that he needs to learn and develop and be healthy. We've seen the progress that has been made through the hard work and support of our family and friends, his doctors, his therapists and others. This work will continue. Nicholas's development will continue. And things will be fine, despite the ignorance of others. We will persevere and give Nicholas the best life possible, with the help of people who truly care about him and are able to "accommodate" his needs every step of the way. Rod and Susan Downey Portugal Cove-St. Philip's
Govind Rao

Change Day comes to Canadian health care - but will it make a difference? - Healthy Debate - 0 views

healthydebate.ca/...care-will-it-make-a-difference

from heather quality provinces

shared by Govind Rao on 29 Mar 16 - No Cached
  • by Vanessa Milne, Joshua Tepper & Jill Konkin (Show all posts by Vanessa Milne, Joshua Tepper & Jill Konkin) March 24, 2016
  • It was part of her pledge to wear a hospital gown for one day for Alberta’s Change Day – an initiative that asks health care workers and others to think of one positive change they can make to the system. “When Change Day was introduced, I thought I should look at every strategy through the eyes of my patients,” says Patenaude, a registered nurse and project director with Integrated Quality Management at Alberta Health Services. “To make that more concrete, I made a pledge that I would wear a patient gown to get that sense of vulnerability.”
  • Practitioners have pledged to remember to introduce themselves to patients or to shadow another doctor for a day, and the public have vowed to walk more or to help prevent bullying. 
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  • Saskatchewan began having a Change Day in 2014, and BC followed in 2015.
Heather Farrow

Lawsuit to reignite health-care debate; Cambie Surgery Centre's practice of billing pat... - 0 views

www.fpinfomart.ca/doc/doc_print.php?key=pr|246199|ntgm|20160831|255048441

day court privatization private clinics

shared by Heather Farrow on 31 Aug 16 - No Cached
  • The Globe and Mail Wed Aug 31 2016
  • Brian Day, a crusader for greater private health-care access, will be in a Vancouver courtroom next week for the start of a lawsuit challenging provincial rules that pertain to his clinic's practice of billing patients for procedures offered in the public system. While the hearing challenging B.C. regulations that ban private care for medically necessary services is expected to last six months, a bullish Dr. Day said in an interview on Tuesday that victory is inevitable "because we're right." The hearing begins next Tuesday in B.C. Supreme Court. On one side is the Cambie Surgery Centre, which describes itself as Canada's only free-standing hospital of its kind, as well as patients who are listed in the lawsuit as plaintiffs. On the other side is British Columbia's Medical Services Commission and the provincial Health Ministry.
  • The case promises to reignite a debate whose last major legal test occurred in 2005, when the Supreme Court of Canada ruled that a Quebec ban on private health care was unconstitutional. Dr. Day is the medical director at the Cambie clinic, which specializes in anthroposcopic surgery and allows patients to pay out-of-pocket rather than wait for care in the public system. The provincial government has previously audited the clinic and alleged its billing practices were illegal, though for years it did little to actually intervene. Dr. Day and his patients argue that restrictions on private care are unconstitutional. The orthopedic surgeon and past-president of the Canadian Medical Association said he is motivated by a key belief. "You should not suffer or die because of a wait list," he said. "Access to a waiting list is not access to health care." The B.C. government says it is simply enforcing the law.
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  • "The priority of the Medical Services Commission and the Ministry of Health is to uphold the Medicare Protection Act and the benefits it safeguards for patients in this province," B.C. Health Minister Terry Lake said in a statement on Tuesday. "We expect and require these clinics to come into full compliance with the law, and we remain fully committed to seeing out this case to its resolution." The ministry said it could not comment further because the case is before the courts. But the federal government is also watching the proceedings closely and has sought intervenor status in the case. In a statement from Ottawa, Health Canada said many provisions of the B.C. legislation mirror those of the Canada Health Act, "making this case of significant importance not only to British Columbians, but to all Canadians."
  • Given that Canadians "overwhelmingly" support universally accessible health care, "any challenge to a principle so fundamental to our health-care system is of significant concern to the Government of Canada." During a federal Liberal caucus retreat in Saguenay, Que., last week, Health Minister Jane Philpott said the case and the prospect of health-care privatization are a cause of "concern" for her. "I think I have made it very clear on repeated occasions that our government is committed to firmly upholding the Canada Health Act. The Cambie case deals specifically with that, with the provision of services," she told reporters. "It's fundamentally important to the health-care system in the entire country, not just in British Columbia, that we make sure that medically necessary services are universally insured and there are no barriers to access of those services." Ms. Philpott acknowledged that some health-care services in Canada are delivered privately, citing physiotherapy, which is largely carried out in private clinics because it is not included under the Canada Health Act.
  • But she said anything similar to a user fee is a barrier to people being able to receive medically necessary care. Ultimately, Dr. Day said, the law, facts and evidence are on the side of his argument that Canadians would best be served by a "hybrid" health-care system. "I kind of hope the judge doesn't hear that, and our lawyers would be nervous to hear that, but that's what I believe," he said. Within that system, public hospitals would offer private services and private hospitals would offer public services. He said he also wants to see competition between and within the systems. "Competition breeds excellence," Dr. Day said. © 2016 The Globe and Mail Inc. All Rights Reserved.
Govind Rao

A look at the MRI plan - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|relp|20151019|231698836

from heather diagnostics Saskatchewan private clinics privatization

shared by Govind Rao on 19 Oct 15 - No Cached
  • The Leader-Post (Regina) Mon Oct 19 2015
  • The government announced changes to Saskatchewan's MRI process in the spring, and Premier Brad Wall has made it a priority to push the legislation through the house. The new system will allow people to pay a private clinic for an MRI, effectively skipping to the front of the queue. In return, the clinic will have to provide a second, free, MRI to the public system. Health Minister Dustin Duncan says it will chip away at ballooning wait times and provide more options to patients, but critics say the plan will create a two-tier health system and won't lessen waits at all. Here's a look at the government's plan.
  • The business case One of the biggest questions around the legislation is this: Will any private clinics bite? As Bryan Salte from the College of Physicians and Surgeons of Saskatchewan points out, between the investment in people and equipment, setting up a private clinic is "an expensive proposition," and he's "not sure it's a guaranteed way to make money." Duncan says government is "not going to force anybody to do this." At the end of the day, Duncan says, private clinics are "going to have to determine for themselves whether ... from their point of view, it's a sound business idea."
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  • Wait times Currently, MRI wait time trends are hard to figure out. Because there has been no consistent record-keeping, requests for data are met with several caveats. Looking at raw numbers, waits in 2014 were anywhere from within 24 hours for a Level 1 priority patient, to 287 days for a Level 4 patient. Current wait times also differ markedly between health regions - bad news if you're in Saskatoon, where for the past few years, average waits for all but Level 1 patients have been longer than in Regina. In 2014, for example, patients waited 10 days for a Level 2 scan in the Regina Qu'Appelle Health Region, compared with 19 days in the Saskatoon Health Region. Level 3 waits were 58 days in Regina and 86 in Saskatoon, and Level 4 waits were 96 and 120 days respectively. Duncan admits part of that might come down to overuse of diagnostic imaging - something the Saskatchewan Medical Association and government are working on.
  • That's backed up by the fact that in the past eight years, the number of publicly funded scans in Saskatchewan has more than doubled and there are more MRI machines, but it hasn't made a dent in wait times. Health policy analyst Steven Lewis can't see the new approach reducing waits, because the only way you do so "is if demand stays constant while you're increasing capacity - and that never happens." Duncan is convinced the new approach "will help toward wait times," but Dr. Ryan Meili, a family physician in Saskatoon and vicechair of Canadian Doctors for Medicare, disagrees. As evidence, Meili points to Alberta. It has private MRIs, he says, yet it "has the longest wait times for MRIs in the country." Erosion of public health?
  • You would expect Meili to be ideologically opposed to the privatization of MRIs - after all, he ran for NDP leadership and is a vocal opponent of privatizing any aspect of health care - but he also has "evidence-based" objections. "It starts to just further reinforce this idea that we need to privatize care, piece by piece, and it erodes confidence in the system," he says. Duncan argues that paying out of pocket for MRIs already "happens in Saskatchewan today" when people head to Alberta or the U.S. for a scan. The provincial health system doesn't stop them, he says, but "we don't get any benefit from people doing that." Duncan says at least this way, "the public system will get a scan for each one paid for out of pocket."
  • Because MRIs are generally a diagnostic tool, Lewis says the biggest risk in the change is that people who need a scan and pay out of pocket will end up getting treatment sooner than those who don't pony up the cash. "It's troublesome on so many levels," he says. egraney@leaderpost.com Twitter/LP_EmmaGraney
Heather Farrow

90-year-old to keep job she's held for 70 years - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=ln|tost|20160412|244562637

shared by Heather Farrow on 12 Apr 16 - No Cached
  • Toronto Star Tue Apr 12 2016
  • Talk about a loyal employee: Elena Griffing has just celebrated her 70th year working for the same San Francisco Bay Area hospital, and she has no plans to retire anytime soon. Sutter Health Alta Bates Summit Medical Center has marked Griffing's milestone and her recent 90th birthday, spokeswoman Carolyn Kemp said. But for Griffing, who has held several different positions in her decades of employment, every day on the job is a celebration. "I can't wait to come to work every day, this is my hospital," she said. "I enjoy anything I can do to be of service."
  • She isn't kidding. As if her employment longevity wasn't enough, consider this: She has taken only four days of sick leave in her 70 years of work. On a Sunday about 15 years ago, she had her appendix removed at the Berkeley facility. The following day, she put on her robe, walked one floor down from her hospital room and got to work. "It was no big deal. There was nothing wrong with my hands, I could still type and do what I had to do." But when the doctor got wind, he sent her home.
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  • Griffing's first day on the job was April 10, 1946, when she was 20. Her first job was in the lab where frogs and rabbits were injected with a woman's urine to determine if she was pregnant. She currently works in patient relations four days a week. .If she has her way, she'll keep working "until they throw me out or they carry me out in a box."
Heather Farrow

Hurry up and wait - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|tidp|20160824|254534355

day privatization private clinics court

shared by Heather Farrow on 24 Aug 16 - No Cached
  • The Timmins Daily Press Wed Aug 24 2016
  • How did it ever come to this? How did supposedly intelligent men and women, given the responsibility for running our health-care system, allow things to deteriorate so badly? More importantly, how did we-the public-allow ourselves to be duped all these years by spineless, self-serving politicians?
  • Earlier this year, an Ontario teenager, Laura Hillier, died while waiting for a stem-cell transplant. She was only 18 years old, and had her whole life ahead of her. Unfortunately for Laura, she made the mistake of getting sick in Ontario, a province where-like most of the rest of Canada- we've had our heads buried in the sand for far too long when it comes to how we fund our health-care system. This young girl died, not because they couldn't find a donor-there actually was one-but because those in charge couldn't find a way to fund the procedure that would have saved her life.
  • ...8 more annotations...
  • Then there's little Meghan Arnott, age 12, who's waiting for surgery in British Columbia to correct a complication brought on by Crohn's disease. Unfortunately for Meghan, she's been told her surgery may have to be postponed eight or nine months due to a severe shortage of nurses in B.C., caused by-you guessed it-chronic underfunding of our health-care system by the government. Meanwhile, this young girl waits in excruciating pain and discomfort, yet another invisible victim of Medicare.
  • Or how about 16-year-old Walid Khalfallah, who hails from Kelowna, British Columbia? Walid is now a paraplegic thanks to his encounter with our health-care system. All because those running the show felt it was a reasonable risk for a young boy of 13 to wait 27 months-that's right, folks, I said 27 months-for surgery on his spine. By the time Walid had the surgery in 2012, at Shriners Hospital in Spokane, Washington, it was too late.
  • Still think we have the best health-care system in the world? Not by a long shot. Despite statements by elected officials to the contrary, Canada's health-care system is no longer something we Canadians can-or should-be proud of. Stories like those of Laura, Meghan and Walid, while admittedly anecdotal, point to inadequacies in how Medicare is funded and how decisions are made when it comes to deciding on what programs receive funding and which don't.
  • It's sort of like winning the lottery. If you belong to a demographic that is older and more inclined to vote-baby boomers, for example, in need of cataract surgery or hip replacements-then you might very well be in luck. If you happen to be a child, however, or suffering from some less-than-"sexy" disease, then good luck, you're on your own.
  • No one's life should have to depend on the roll of the dice. That's crazy. Fortunately, after years of delays and legal maneuvering by the B.C. Government, Dr. Brian Day's charter challenge is finally about to get under way this coming September in Vancouver. The case, which will be argued before the Supreme Court of British Columbia, will include six other plaintiffs, including Walid Khalfallah, in addition to Dr. Day. Sadly, two of the six plaintiffs have died as a result of delayed access to care. The irony of that should be lost on no one.
  • In 2005, the Supreme Court of Canada ruled that those living in the province of Quebec should have the right to purchase private health-care insurance under the Quebec Charter. This was known as the Chaoulli case. Dr. Jacques Chaoulli successfully convinced all seven judges hearing the case that patients were suffering and, in some cases, dying while waiting to access care. Dr. Day and his fellow plaintiffs will be arguing that those living outside Quebec should have similar protection under the Canadian Charter of Rights and Freedoms.
  • Not surprisingly, the B.C. Government and Government of Canada will be arguing the opposite, as will a number of special interest groups, including representatives of the B.C. Health Coalition and Canadian Doctors for Medicare, who have applied for and been granted intervener status. While I have no doubt that Dr. Day will ultimately win his charter challenge-after all, Dr. Day and those representing the more than two million Canadians currently suffering on waiting lists, including Walid and the other five plaintiffs, are on the side of the angels. As for all those bureaucrats, lawyers and elected officials-armed with an endless supply of "lies, damn lies, and statistics," desperately trying to justify maintaining the status quo-I'm not really sure whose side they're on.
  • Certainly not yours or mine. Because if they were, they'd come clean and admit the truth. Canada's health-care system is not sustainable and on the verge of complete and total collapse. Spending millions of dollars to defend the indefensible is not only wrong, it's obscene. Just ask Laura, Meghan, Walid and the friends and relatives of the two plaintiffs who died after waiting for both care and justice. Access to a waiting list is not access to care, as the judges in the Chaoulli case so rightly pointed out 11 years ago. Hopefully, when the decision is handed down, once all the arguments have been heard this fall in British Columbia, we'll finally be able to have that "adult" conversation we've been avoiding for the past 20 years and actually do something to fix the mess we find ourselves in. One can only hope. Stephen Skyvington
Heather Farrow

This Equal Pay Day, let's mobilize for change | rabble.ca - 0 views

rabble.ca/...l-pay-day-lets-mobilize-change

equity gender Ontario campaign wages

shared by Heather Farrow on 26 Apr 16 - No Cached
  • Every year, women around the world celebrate (angrily) the day their average full-time full-year earnings have caught up to men's average full-time full-year earnings from the year before. This year in the United States that day fell on April 12. In Germany it was March 19. In Switzerland it was February 24. In Ontario? Equal Pay Day* comes on April 19.
  • o help us better understand gender pay gap dynamics in Ontario, Dr. Kendra Coulter at Brock University conducted a survey of retail workers, an already low-wage and feminized sector. Sheetal Rawal, a lawyer and pay equity expert, contributed analysis and context, and I helped out with some numbers. Our whole report can be found on Dr. Coulter's website, revolutionizingretail.org.
  • Equal Pay Day is calculated based on the difference in full-time earnings between men and women, but it turns out it is not just about wage equity, but also about "hours equity."
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